(1) Field of the Invention
This invention relates to surgery, and more particularly to skin surgery and local flaps. A plastic surgeon is one having ordinary skill in this art.
(2) Description of the Related Art
Local skin flaps have been known for many years. A flap of skin is moved from one location to another location. The donor tissue is obtained from the area adjacent to the defect and is not detached from the body but merely moved, always being attached to other tissue. Stated otherwise, when some skin is removed along with a skin defect, then a flap of skin adjacent to it is moved to cover where the defect was removed.
Although the basic concept is simple, the practice requires considerable knowledge of geometry, skin biomechanics, and in the case of facial surgery, knowledge of facial anatomy combined with a sense of aesthetics and an appreciation for shapes, symmetry, and color (see page 3 of Ian T. Jackson's Local Flaps in Head and Neck Reconstruction, copyrighted and published in 1985 by The C. V. Mosby Company, St. Louis, Toronto, and Princeton).
One of the basic considerations is to obtain a flap of the approximate size of the defect to be covered and to move it there. If the skin is stretched beyond safe limits, there is likely to be a compressed circulation with disastrous results. Also, the skin over the defect, itself, should probably be stretched as little as possible, although there obviously must be some stretching of skin in the general area. This requires that the area of the defect should be inspected to determine the best position for the flap placement. Generally, if an attempt is made to use a small flap to fill a big hole, there will be a loss of the flap. Also, if there is an attempt to extend the flap outside of its blood supply, there will be a failure and a loss of the flap.
Jackson, in his book identified above, suggests that often times that a piece of gauze is used to assess whether a flap will do what is required (pg. 8, Jackson, supra).
The book identified above describes many of the basic type of flaps and the basic geometry for them, e.g., the rotation flap (beginning of page 7), the transposition flap (beginning of page 10), the advancement flap (page 12), the island technique (page 14), and then specific types such as the rhomboid (Limberg) flap (page 16), the dufourmentel flap (Lambeau En L Pour Losange, "LLL" flap) (page 20), as well as the bilobed flap (page 21).
BLISS, U.S. Pat. No. 4,576,163 discloses a surgical implement which is pressed against the skin to leave a mark on the skin to indicate where it would be desirable to remove a defect and close the skin removed with a small hairline scare. This device is a rigid metal device that would produce one pattern for one size incision.
WILSON, U.S. Pat. No. 4,192,312 discloses a patch-like sheet of material adapted to be placed over skin tumors for aiding the surgeon or making the optimum size and shape incision for removing the tumor. A sheet of material was provided with openings, as is understood, the sheet of material would be attached as by adhesion to the skin, and there would be a removal of all or part of the patch along with the skin tumor and surrounding skin.
LEE, U.S. Pat. No. 4,279,259 discloses a mammometer for making measurements of mammary glands for doing breast surgery. The meter would have certain holes and openings therein for marking the skin.